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Using Absolute Risk to Predict Fracture Risk in Clinical Practice

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Bone Densitometry for Technologists

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Abstract

One of the most important uses of the bone density measurement is the prediction of the patient’s fracture risk. In the past, the statistical measure called relative risk (RR) was employed to convey the patient’s risk of fracture to the treating physician as well as to the patient. This resulted in statements such as “the patient’s risk of spine fracture is increased fourfold” or the “patient’s RR of spine fracture is 4.0.” Although this was the best that previously could be done, such statements actually conveyed little useful information. If a patient’s risk of spine fracture is increased fourfold, what does that really mean? The risk of fracture is fourfold greater than what? And while a fourfold increase in fracture risk sounded dire, it might not be. If the unstated baseline risk was extremely small, a fourfold increase in that extremely small baseline risk is still going to be very small. For this reason, the expression of a patient’s fracture risk in clinical practice as absolute risk (AR) is overwhelmingly preferred. The use of RR is considered obsolete and inappropriate. The utility of RR as a statistical expression of risk is unquestioned in clinical trials, but it has no role in clinical practice in the interpretation of DXA bone density data.

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Notes

  1. 1.

    Global fracture risk refers to the risk of all fractures combined.

  2. 2.

    Site-specific fracture risk is the risk of a specific type of fracture, such as spine fracture risk or hip fracture risk.

  3. 3.

    Cohorts included the Rotterdam Study, the European Vertebral Osteoporosis Study (EVOS), the Canadian Multicentre Osteoporosis Study (CaMOS), Rochester, Sheffield, Dubbo, Hiroshima, and Gothenburg (2 cohorts).

  4. 4.

    DMARDs—disease-modifying antirheumatic drugs. These are drugs such as methotrexate, Imuran, Cytoxan, and Plaquenil.

  5. 5.

    TNF blockers are drugs such as Enbrel, Humira, and Remicade.

  6. 6.

    On the FORE website, it is noted that the FORE FRC is closely aligned with FRAX®, web version 3.0. Although the current web version of FRAX® is version 3.7, updates 3.1–3.6 do not affect this alignment.

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Authors and Affiliations

  1. Clinical Research Center of North Texas, Denton, TX, USA

    Sydney Lou Bonnick MD, FACP, CCD & Lori Ann Lewis MRT, CDT

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  1. Sydney Lou Bonnick MD, FACP, CCD
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  2. Lori Ann Lewis MRT, CDT
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Bonnick, S.L., Lewis, L.A. (2013). Using Absolute Risk to Predict Fracture Risk in Clinical Practice. In: Bone Densitometry for Technologists. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3625-6_8

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  • DOI: https://doi.org/10.1007/978-1-4614-3625-6_8

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  • Online ISBN: 978-1-4614-3625-6

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